HomeMy WebLinkAboutBuilding Permit #521 - 323 CHESTNUT STREET 4/6/2009Permit N
Date Issued: y �0
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
I IMPORTANT: Applicant must complete all items on this nage I
LOCATION
'MAP NO: PARCEL: ZONING DISTRICT: Historic :District
Machine Shop
yes no
ves no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
ane family
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Repair, replacement
Assessory Bldg
Others:
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
PTION OF WORK TO BE PREFORMED:
Identification Please Type or Print Clearly)
OWNER: Name:_ ,,�/,Or//t� e,QLG•0�'y Phone: %- 61 Y--I-F�'e
Address:
CONTRACTOR Name. �',�c'/tea'`` Phone:
Address:
Supervisor's Construction License:, Exp. Date; --z/,-;?//
Home Improvement License:„ Exp. Date: Flo
ARCHITECT/ENGINEER Phone:
Address: Reg. No
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ FEE: $"
Check No.: ` //� Receipt No.: C�2 �� G
NOTE: Persons contracting with unregistered contractors do not have access to the guarantypnd
envuwner
7
Location Z �'f--Gd iy-� 7—
No.
No. Date
TOWN OF NORTH ANDOVER
TOTAL $
Check #// �p
21 9 .1 0 ----�
Building Inspector
Certificate of Occupancy
$
3,cNusE��
Building/Frame Permit Fee
$
Foundation Permit Fee
_
$
Other Permit Fee
$
TOTAL $
Check #// �p
21 9 .1 0 ----�
Building Inspector
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/Massage/Body Art
Swimming Pools
Well
Tobacco Sales
Food Packaging/Sales
Private (septic tank, etc.
Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
LOcatea 3ts4 uS ooa bireet
FIRE DEPARTMENT - Temp Dumpster on site yes - no
Located at 124 Main Street
Fire Department signatureldate
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
NOTES and DATA — For department use
❑ Notified for pickup - Date
Doc.Building Permit Revised 2008
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
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9
Massachusetts - Department of Public Safeta.
Board nr Building Regulations and Standards
Construction Supervisor License
License: CS 72173
Restricted to: 00
CHRISTOPHER F RIVET
207 WINTER ST
N ANDOVER, MA 01845
Expiration: 6r2Ml0
Tr#: 25403
Board of. Building ptgulations and Sta
MENT COkTRA& OF
HOmEIMPRGVE
Registration: 139962
F-xpirrti in- -T-r# - 132286
Individuni
CHRISTOPHER P. RNET
CHRISTOPHER RIVEI
2 MINTER ST. ce;'
01
ER
N. ANOPY -,1-4A G1845 iliFininistratur
r
The Commonwealth ®f Massachusefts
Department of Fire Services
Office of the State Fire Marshal
P. 0. Box 1025 State Road, Stow, MA Oim
PERMIT
North AndoverDate'
1�ermit No
( Cityof Town) ( If Applicable) .Dig Safe Num er
In accordance with the provisions of M. G.L 14 8 Chapter1Q_ as provided in section 5 7 _Z(M R 34
Start Date
This Peraut is granted to:
Full name of person, Firm or Corporation
Pen=sionto locate dumpster for construction/renovation/demolition of building.
Comments: dumpster must be. 25' from structure if unable to place with reauired
Restrictions: clearance dumpster must be covered with plywood or tarp end of work -day
at�7� .� �� f C i fliv i S% f F
( Give location by street andVZL
suchas top adequate identification of location)
FeePaidS 50.00 � Fire Chief
This Permit will expire ( Signature of offical granting permit) Offical granting permit ( Title )
NQ FD 6456
Date..
TOWN OF NORTH ANDOVER
RECEIPT
CHU
This certifies that .0& V ....
C?
has paid ... X15............()-
...............................................................
for..................................
Receive,,,—) .....................
Department.......//............................................................
(�N WHITE: Applicant CANARY: Department PINK: Treasurer
1 nts t.urarnunweuacn aj massacauseccs
Department of Industrial Accidents
Office of Invesdgadons
600 Washington Street
Boston, MA 02111
www.mtass gov/dda
Workers' Compensation Insurance Affidavit: Builders/ContractorsMectricians/Plumbers
Name (Business/Orgmization/individual):
Address: 07 AjlAj';-I?
City/State/Zip: OVO, AMIX
Are you an employer? Check the appy
1.0 I am a employer with f
�-,
� loyees (full and/or part-time)-
2.2 1 am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.] -
3.0 I am a homeowner doing all work
myself. [No workers' comp -
insurance required.] t
Phone.#: 5�o F- A6-, 3 /l S
nate bor.
4. 0 I am a general contractor and I
have hired the sub -contractors
listed on the -attached sheet
These sub -contractors have
employees and have workers'
comp. insurance.# .
5. 0 We are a corporation and its
officers have exercised fiheir
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
Type of project (required.,
6. '0 New construction
.7: Okemodefing
8. ❑ Demolition
:9. Buiilding.addition
10.0 Electrical repairs or additions
11.0 Plumbing repairs or additions
12.0 Roof repairs
13.0 Other
`Any applicant that checks box #1 must also fill out the section below showing thea• worldrs' cotopasadan policy information.
t Homeown-ms who sub:rrit this affidavit indicating they an: doing all work and then hire outside contractors most submit a new affidavit indicating such.
;Contractors dist check this box most attached an additional sheet Showing the name of the subcontract and state whether ornot those catities have
employees. If the sub-contracthave employees, they must provides their wmken' comp. policy number.
I am an employer that is providing workers' compeMation insurance for my employees Below is the policy and job site
information.
Insurance Company Name: s�/.1' ���CG �/%7%f,Q RAI—
Policy # or Self -ins. Lie. #: Expiration Date: a�
Job Site Address: 30-f"iflf�T" `%�'C �1� ./State/Zip: ya F ADO �O/yt/.r
City
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure, to secure coverake as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverMe verification.
I do herebyce er the p penalties of perjury that the information provided above is true and correct
Si ggar`e: Date:
Phone 1k � % 191-,5:/Y
uffwm-use only. oo not Vrae to arts area, tb be completed by city or town official
City or Town:' PermitUceme #
Issuing nthority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
it Person: Phone #:
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ACORD. CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDIYYYY)
INSRADD'
11/17/2008
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
MacDonald & Pangione Insurance Agency, Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 428
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
104 Main Street
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
North Andover, MA 01845
INSURERS AFFORDING COVERAGE NAIC #
INSURED Christopher Rivet
INSURER A: PREFERRED MUTUAL INS CO 15024
207 Winter St.
INSURER B:
N Andover, MA 01845
INSURERC:
INSURER D:
PERSONAL 8 P.DV INJURY $ 1,000,000
INSURER E:
CAVPDA(_FC
- - -
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR.THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRADD'
LTR
D
POLICY NUMBER
CPP 0150 57 0105
POLICY EFFECTIVE
ATE MIDD
09/26/08
POLICY EXPIRA710N
TE MID /YY
09/26/09
LIMITS
EACH OCCURRENCE $ 1,000,000
A
GENERALLIABIUTY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE ® OCCUR
DAMAGE TO TED
PREMISES FREoc$ 100,000
MED EXP (Airy one person) $ 5,000
PERSONAL 8 P.DV INJURY $ 1,000,000
- - -
- - -
- — -
GENERAL AGGREGATE $ 2,000,00 0
GEN'- AGGREGATE LIMIT APPLIES PER
X POUCY PROT LOC
PRODUCTS- COMPlOP AGG $ 1,000,000
AUTOMOBILE
LIABILITY
-
ANY AUTO
_
COMBINED SINGLE LIMIT $
(Ea accident)
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY $
(Per person)
HIRED AUTOS
NON-OWNEDAUTOS
BODILY INJURY $(Per accident)
PROPERTY DAMAGE S
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
ANY AUTO
OTHER THAN EA ACC S
--EAUTO
ONLY: AGG $
EXCESSNMBRELLAUABILtTY
OCCUR CLAIMS MADE
EACH OCCURRENCE S ^V
AGGREGATE $
DEDUCTIBLE
]RETENTION
$
$
_
S
WORKERS COMPENSATION AND
LIABILITY
TWTEMPLOYERS
'r OR -
E -L EACH ACCIDENT $
ANY PROPRIETORIPARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
E -L DISEASE - EA EMPLOYEE $
It yes, describe under
SPECIAL PROVISIONS below
OTHER
EL DISEASE - POLICY LIMIT S
DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate holder as listed below
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION:
Town of North Andover
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
120 Main Street
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL
No Andover, MA 018455
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AU1'HOR¢EO REPRESENTATIVE
ACORI) 25 r2nnunm
0ACORD CORPORATION 1988
Kitchen Remodel
Work to be completed includes:
PROPOSAL
Shaun & Deb Callagy
323 Chestnut Street
North Andover, MA 01845
(H)978-688-9863
shrink58@yahoo.com
April 5, 2009
• Building Permit & dumpster permit $ 450.00
• Dumpster ( additional dumpsters will be extra) $ 500.00
• Demo Kitchen — To include removal of all appliances, cabinets and
ceiling. Remove vinyl floor and underlayment. Remove dining room
wall. Remove dining room floor. Remove closet. $ 1,950.00
• Electrical — Install eight, six inch recessed lights. Two, four inch recessed
lights. Run four new circuits. Install new switches and receptacles.
Install under cabinet lighting. Wire for two pendants over island.
Install outlet in island. $ 3,375.00
• Hang new ceiling and two exterior walls and plaster.
• Install two new double casement windows.
• Install base and wall cabinets. Install crown moulding around cabinets
• All necessary plumbing.
• Install new 2 1/4Red oak flooring. Sand and finish.
• Install new baseboard where needed. Trim out two new windows.
TOTAL LABOR AND MATERIAL
Terms: $ 5,355.00 to start Cabinet cost-
$ 5,355.00 after plastering Granite cost-
$ 5,365.00 when complete Total project cost
Submitted By: Chris Rivet MA Lie #CS072173 HIC #139962
207 Winter Street (C) 508-265-3115 (H) 978-794-1165
North Andover, MA 01845
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are
You are authorized to do the work as specified. Pay
Date_Z/— — Signati
Date : _- D � Signati
$ 1,850.00
$ 1,800.00
$ 1,700.00
$ 1,100.00
$ 3000.00
$ 350.00
$16,075.00
$ 10,000.00
$ 4,500.00
$ 30,575.00